Activity recommendations and lifting restrictions after gynecologic surgery are based on
tradition and anecdote. Despite the paucity of evidence to support such recommendations,
in a recent survey, 82-86% of minimally invasive gynecologic surgeons recommended
postoperative lifting restrictions. Meanwhile, other surgical specialties have begun to
depart from these traditional restrictions, recognizing not only the unclear health
benefits of a prolonged convalescence, but the economic implications of arbitrarily
restricting postoperative labor force participation. For example, following inguinal
hernia repair, patients who were able to decide when to return to work took a
significantly shorter period of sick leave and hernia recurrence was not found to be
higher in those resuming activities the day after surgery.
With respect to prolapse surgery, recommendations related to weight restrictions are
primarily based upon theoretical avoidance of intra-abdominal pressure which could
compromise the success of a recent reconstructive pelvic floor surgery. However, in a
research study of healthy volunteers, daily physiologic events such as Valsalva,
coughing, and rising from supine to upright positions generated considerably more
intra-abdominal pressure than lifting. In animal studies, mechanical stimulation improves
skeletal muscle healing by promoting remodeling, myoblast chemotaxis, and
differentiation.6 Thus studies have challenged the notion that avoidance of
weight-bearing activities is protective to the reconstructed pelvic floor.
In a recent randomized controlled trial of restrictive versus liberal activity
recommendations following prolapse surgery, liberal activity recommendations were
associated with similar patient satisfaction yet no differences in short-term anatomic
outcomes. While this study added important evidence, it was not powered to detect
differences in early anatomic prolapse recurrence, and the literature remains
inconclusive regarding the risks (or absence thereof) of recommending liberal resumption
of activities following prolapse surgery.
Therefore, the objective of the EVeRLAST study is to conclusively determine whether
expedited resumption of postoperative activity levels is non-inferior to standard
activity restrictions with respect to anatomic and functional outcomes. We recently
presented short-term outcome data, collected three months after surgery, which confirmed
that expedited activity is non-inferior to standard activity limitations. We now propose
to further follow this study population, with repeat assessments two years after surgery.
We hypothesize that those who received expedited postoperative activity instructions will
continue to demonstrate non-inferior anatomic and symptomatic outcomes two years after
prolapse surgery. We will test this hypothesis by completing the following specific aims.
The follow-up will be conducted remotely via Zoom interviews.
Specific Aim 1: Determine if expedited resumption of postoperative activity levels
results in non-inferior symptomatic outcomes when compared to standard activity
restrictions at two years after the original surgery.
Specific Aim 2: Compare objective and subjective measures of physical function two years
after surgery between those receiving expedited versus standard activity restrictions.
Measures include a 2-minute walk test (2MWT), chair stand test, and the Activities
Assessment Scale (AAS).
Specific Aim 3: Compare objective and subjective measures of and pelvic floor function
two years after surgery in those receiving expedited versus standard activity
restrictions. Main outcomes include retreatment (e.g., pessary, surgery), objective
anatomic POPQ data, where available, the Pelvic Floor Distress Inventory (PFDI) and
impression of improvement using the Patient Global Impression of Improvement scale
(PGI-I).